食管癌三维适形放疗前后肺功能、生活质量的变化及放射性肺炎的影响因素分析  

Changes of Lung Function and Quality of Life Before and after Three Dimensional Conformal Radiotherapy for Esophageal Carcinoma and Influencing Factors of Radiation Pneumonitis

作　　者：滕菲[1] 孙晓静 田媛[1] 冉玉格 刘婵 李曙光 TENG Fei;SUN Xiao-jing;TIAN Yuan;RAN Yu-ge;LIU Chan;LI Shu-guang(Department of Radiotherapy,North Hospital of Affiliated Hospital of Hebei University,Baoding,Hebei,071000,China;Department ofRadiotherapy,The fourthHospital ofHebeiMedicalUniversity/HebeiCancerHospital,Shijiazhuang,Hebei,050019,China)

机构地区：[1]河北大学附属医院北院放疗科,河北保定071000 [2]河北医科大学第四医院/河北省肿瘤医院放疗科,河北石家庄050019

出　　处：《现代生物医学进展》2021年第6期1120-1124,共5页Progress in Modern Biomedicine

基　　金：国家自然科学基金青年基金项目(31600616);保定市科技计划项目(18ZF266)。

摘　　要：目的:探讨食管癌三维适形放疗前后肺功能、生活质量的变化及放射性肺炎的影响因素。方法:收集2017年11月~2019年11月在我院进行三维适形放疗的食管癌患者102例,对患者放疗前后的肺功能进行检测对比,并采用生活质量评价简表(QLQ-C30)对患者放疗前后的生活质量进行评估对比。统计患者放疗后放射性肺炎的发生率,根据患者放疗后是否发生放射性肺炎将患者分为放射性肺炎组和非放射性肺炎组,对两组患者的临床资料进行对比分析,采用单因素和多因素Logistic回归分析影响食管癌三维适形放疗后放射性肺炎发生的影响因素。结果:放疗前后患者肺活量(VC)占预计值的百分比、用力肺活量(FVC)占预计值的百分比、第一秒用力呼气容积(FEV1)占预计值的百分比、最大通气量(MVV)占预计值的百分比对比无统计学差异(P>0.05),放疗后患者一氧化碳弥散量(DLCO)占预计值的百分比低于放疗前(P<0.05)。放疗后患者的QLQ-C30各项评分均低于放疗前(P<0.05)。102例患者中放疗后出现放射性肺炎33例,发生率为32.35%。经单因素分析显示,两组患者在性别、体质量指数(BMI)、吸烟史、饮酒史、肿瘤大小、病理类型、肿瘤位置、合并化疗方面比较差异无统计学意义(P>0.05),而在年龄、合并肺基础疾病、全肺接受20Gy的体积(V20)、全肺照射平均剂量(MLD)方面比较差异有统计学意义(P<0.05)。经多因素Logistic回归分析显示,年龄≥60岁、合并肺基础疾病、V20≥30%、MLD≥1200cGy是食管癌三维适形放疗后出现放射性肺炎的危险因素(OR=1.309、1.193、1.416、1.309,P<0.05)。结论:食管癌三维适形放疗会对患者的肺部弥散功能、生活质量产生负面影响。部分患者放疗后会出现放射性肺炎,其主要受年龄、肺基础疾病、V20、MLD的影响。Objective:To analyze the changes of lung function and quality of life before and after three-dimensional conformal radiotherapy for esophageal cancer and the influencing factors of radiation pneumonia.Methods:102 patients with esophageal cancer who were treated by three dimensional conformal radiotherapy in our hospital from November 2017 to November 2019 were collected for investigation and study.The pulmonary function of patients before and after radiotherapy was tested and compared.The quality of life of the two groups before and after radiotherapy was evaluated and compared by quality of life assessment(QLQ-C30).According to the incidence of radiation pneumonia after radiotherapy,the patients were divided into radiation pneumonia group and non radiation pneumonia group.The clinical data of the two groups were compared and analyzed.The influencing factors of radiation pneumonia after three-dimensional conformal radiotherapy for esophageal cancer were analyzed by single factor and multi factor Logistic regression.Results:There was no significant difference in vital capacity(VC)in the predicted value,forced vital capacity(FVC)in the predicted value,forced expiratory volume in the first second(FEV1)in the predicted value and maximum ventilation volume(MVV)in the predicted value between the patients before and after radiotherapy(P>0.05).The percentage of diffusion capacity of carbon monoxide(DLCO)in the predicted value after radiotherapy is lower than that before radiotherapy(P<0.05).The scores of QLQ-C30 after radiotherapy were lower than those before radiotherapy(P<0.05).Among the 102 patients,33(32.35%)had radiation pneumonia.Single factor analysis showed that there was no significant difference in gender,body mass index(BMI),smoking history,drinking history,tumor size,pathological type,tumor location,combined chemotherapy between the two groups(P>0.05),but there was significant difference in age,combined basic lung disease,volume of whole lung receiving 20GY(V20),average dose of whole lung irradiation(MLD)(P<0

关 键 词：食管癌 三维适形放疗 肺功能 生活质量 放射性肺炎 影响因素 

分 类 号：R735.1[医药卫生—肿瘤]